CHA News Article

CMS Proposes 2018 Policy, Payment Rate Changes for ESRD Facilities

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule to update and revise the calendar year (CY) 2018 end-stage renal disease (ESRD) prospective payment system (PPS). Comments are due Aug. 28.

The proposed CY 2018 ESRD PPS base rate is $233.31, an increase of $1.76 to the current base rate of $231.55. CMS projects that the updates for CY 2018 will increase total payments to all ESRD facilities by 0.8 percent. Hospital-based ESRD facilities will have an estimated 1 percent increase in total payments, and freestanding facilities have an estimated 0.8 percent increase. The proposed rule would also make the payment rate for renal dialysis services serviced by an ESRD facility to individuals with acute kidney injury the same as the ESRD PPS base rate.

The proposed rule suggests changes to the ESRD Quality Incentive Program (QIP). Because the Trade Preferences Extension Act of 2015 provides coverage for renal dialysis services to an individual with acute kidney injury, CMS seeks comment on including this population in ESRD QIP.

CMS proposes to shorten and simplify the performance score certificate beginning in payment year 2019. The certificate would indicate the facility’s total performance score for the payment year, information sufficient to identify the facility (e.g., name and address) and information showing the facility’s total performance score compared to the national average.  

In payment year 2020, CMS proposes changes to the extraordinary circumstances exception (ECE) policy. Changes include allowing a facility to submit a form signed by the CEO or designated personnel, expanding the reasons for requesting an ECE, and specifying that a facility does not need to be closed to request or receive consideration for an ECE.   

Beginning with payment year 2021, CMS proposes replacing two of the existing ESRD QIP vascular access type measures with Hemodialysis Vascular Access: Standardized Fistula Rate Clinical Measure and the Hemodialysis Vascular Access: Long-Term Catheter Rate Clinical Measure, which are endorsed by the National Quality Forum. CMS also proposes revisions to the Standardized Transfusion Ratio clinical measure, making it consistent with the specifications endorsed by the National Quality Forum.

A fact sheet is available on the CMS website.